“I Can’t Sleep Doc”

Insomnia is a huge problem in the United States. We spend over $10 billion a year on sleep-related treatments and it’s estimated the economy loses over $40 billion in worker productivity due to sleeplessness.

Insomnia is a very complex subject that I can address only briefly in this column. This week I’ll focus on some causes of insomnia and next week I’ll cover prevention and treatment of sleep disorders. It’s important to remember that insomnia is not a disease – it is a symptom of an underlying problem.

Insomnia is classified into three broad categories based on how long a person has it. The first is transient insomnia that lasts a week or less and is usually due to some type of temporary life stressor. It can also be the result of environmental factors such as sleeping in an unfamiliar bed or surroundings or having too much light or noise in a room. The second type of insomnia is short-term insomnia that lasts one to six months. It is usually caused by persistent stress. Finally, chronic insomnia lasts more than six months.

There are many causes of chronic insomnia, the most common of which is anxiety. The primary symptom of people suffering from anxiety is difficulty falling asleep. These folks usually report that they can’t turn their thoughts off at bedtime. I see this frequently in patients who are multi-taskers who feel as though they never get everything finished. Depression may also cause chronic insomnia, though these individuals usually present with “terminal insomnia,” meaning they wake up a few hours early in the mornings.

Pain from arthritis or other conditions like fibromyalgia can also lead to chronic insomnia. Lung disease such as COPD/emphysema and heart disease, especially congestive heart failure, can cause frequent night waking. Chronic insomnia has also been identified as a symptom of Long Covid.

Restless Leg Syndrome (RLS) can cause trouble getting to sleep or staying asleep. Sleep apnea may also cause frequent nighttime wakings. Over-the-counter medication use can be a common cause of chronic insomnia, particularly stimulants found in cold medication.

Caffeine is a huge problem, and one of the first habits I ask about when I see someone who has trouble sleeping. Some people drink too much soda, coffee or energy drinks. I often discover they’re doing it to keep themselves awake during the day because they can’t sleep at night! This is common in teens and college students who are often up late at night playing video games or checking social media. Caffeine can stay in your system for eight hours or longer.

Over-the-counter or prescription sleeping pills can also be habit-forming. People who take these often find themselves unable to stop taking them or they require larger doses to get the same effect. If they do stop them, they can develop “rebound insomnia.” Sleeping pills can also be extremely dangerous when used by older people. They frequently lead to difficulty with balance and coordination, resulting in falls with associated fractures and brain injuries.

Many people subscribe to the incorrect notion that alcohol helps them sleep – it’s actually one of the worst things you can use to self-treat insomnia. While alcohol has depressant effects on the brain, it actually does not allow the brain to enter critical phases of sleep that refresh the brain. If the brain does not get enough deep sleep, the person constantly feels sleep deprived.

People who work alternating shifts can develop a condition called shift work sleep disorder. It is common in people who have brains that are wired to only function properly if they sleep at night. More and more young people are suffering from “sleep phase delay” insomnia. This results from staying up late and sleeping in late (which is actually a normal sleep cycle for the adolescent brain). The problem manifests when they try to go to bed earlier and can’t get to sleep. Pleasant dreams!